Provider Demographics
NPI:1124418397
Name:PEIDLE, SARA LYNNE (RDN)
Entity Type:Individual
Prefix:MS
First Name:SARA
Middle Name:LYNNE
Last Name:PEIDLE
Suffix:
Gender:F
Credentials:RDN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3945 WASHINGTON BLVD
Mailing Address - Street 2:
Mailing Address - City:OGDEN
Mailing Address - State:UT
Mailing Address - Zip Code:84403-1825
Mailing Address - Country:US
Mailing Address - Phone:801-479-4105
Mailing Address - Fax:
Practice Address - Street 1:14253 SPANISH POINT DR
Practice Address - Street 2:
Practice Address - City:EL PASO
Practice Address - State:TX
Practice Address - Zip Code:79938-5384
Practice Address - Country:US
Practice Address - Phone:915-760-0174
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-01-27
Last Update Date:2023-11-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT9396734-4901133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered